The quest for integrated health and social care: A case study in Canterbury, New Zealand

This paper tells the story of the journey made by the District Health Board for Canterbury, New Zealand, towards its goal of providing integrated care for all. It looks at the drivers for change, the leadership values shown by key players and considers the lessons that can be learned from the Canterbury experience.

The changes made to the system since 2007 mean that Canterbury now has a system in which good-quality general practice is increasingly keeping patients who do not need to be in hospital out of it; is treating them swiftly once there; and discharging them safely to good community support.

Key findings

• The stimulus for change in Canterbury was a health system that was under pressure and beginning to look unsustainable.
• Canterbury adds to the small stock of examples of organisations and systems that have made the transition from fragmented care towards integrated care with a degree of measurable success.
• Creating a new system takes time – Canterbury has been working to create ‘one system, one budget’ for at least six years and the journey is far from complete.
• It takes many people to transform a system. A small number of leaders were at the heart of Canterbury’s transformation, but this leadership rapidly became collective, shared and distributed.

Policy implications

• Those wishing to create a system of truly integrated health and social care must have a clear vision. In the case of Canterbury, the mantra 'one system, one budget' is firmly held and articulated.
• Sustained investment is needed to provide staff and contractors with the skills needed to innovate and to support them when they do.
• New forms of contracting may be needed. In Canterbury, this meant the price/volume schedule (the equivalent of the NHS tariff) was scrapped and the budgets for hospital departments were re-built from the base up.